Professional developments: benefits from loss of innocence

As adolescents and young adults we learned that functions of the three primary disciplines – religious studies, law and medicine – were pretty obvious. Prelates had a major role in maintaining stability within society, comforting people and fostering the concept of a next world while avoiding politics. Their rewards lay in the good feelings engendered by their work, acceptance of a coherent philosophy and practice, close contact with like-minded people, and the knowledge that they were secure in a material sense at the level they had chosen to adopt. 

Lawyers administered general rules intended to stabilise society according to the dictates of legislators and the political climate of the age. Their rewards were limited by the ability of people to pay for their projects, but those limits were pretty elastic. 

Doctors and their assistants also provided comfort and reassurance while achieving significantly in various areas, particularly surgery and orthopaedics. Their work was satisfying, but there were frustrations based on the severe curtailment of their ability to handle various diseases and chronic degenerative processes. Their rewards lay in the preservation of a certain mystique combined with a general hold over the population who were fearful of the consequences of diseases in general and accidents, in particular. Their rewards involved long hours devoted to the care of the people, but they were able to self-administer forms of charity that created a sense of meaningful compassion. 

The preservation of confidentiality 

As we emerged into professional life as a doctor we became aware that the three primary professions shared one important attribute, the preservation of confidentiality. In our innocence, most of us did not realise that priest–parishioner, lawyer–client and doctor–patient confidentiality and relationships were extremely complicated. While governed by codes of ethics involving absolute concepts, all things were, in fact, relative. Moreover, the parishioners, clients and patients were themselves potent manipulators of the system.

Early on in hospital practice as a physician I became closely acquainted with a senior member of the ‘animal racing industry’. This man was a brilliant raconteur, and part of my management of him involved the somewhat pleasant duty of listening to a series of intriguing and often amusing stories. Gradually, however, I realised that I was acting, to some extent, as his priest. He revealed some extreme corruption in his industry, even mentioning names, which I deliberately forgot. To keep the non-wealthy devotees of the sport at the owner-trainer level, races were carefully rigged so that no owner or trainer actually went bankrupt and had to give up, thereby reducing the pool of animals, which might have lessened public interest. I realised that he knew I would not tell anybody and he felt better for getting his secrets off his chest.

Muddling of functions between the professions 

As I grew older in the profession, and moved between cities and countries I became increasingly attuned to this muddling of functions between medicine, the law and the church. Looking back, I should have lost my innocence earlier. 

During the course of a long-term GP locum, I noted that the alternate weekends when I was on duty were remarkably busy. I suddenly realised that the bulk of the extra patients belonged to one religious denomination. They came to me for various reasons, but essentially most were women seeking contraceptive advice or prescriptions. My partner in the practice was a rather rigid fundamentalist Protestant, and the only woman doctor in the area was a devout Catholic. The wealthier women were quite frank and indicated that they did not want the inconvenience of large families. The women from a less wealthy suburb within the practice area usually came to me after various attempts to end a pregnancy, fearful of further pregnancies when they already had several children. The husbands of the wealthy Catholic women were well aware of their wives’ attendances and the reason, whereas the women from the poorer section of the community were terrified that I might let their husbands know that they had visited me for these reasons. 

There were other aspects to this process of losing innocence. I was surprised when the senior priest in the area indicated to me that he was well aware of what I was doing, and that in a tortured way, his own confessional acknowledged his passive acquiescence in the matter. He sensed that life for women could be better in general if they had smaller families, and agreed it was better to do things quietly while people like him and me dealt in a lonely way with our own consciences. At that stage I realised I was beginning to understand some of the deeper significance in the short stories of Somerset Maugham, Graham Green and Guy de Maupassant. I moved on to the marvellous O. Henry tales and began to realise, after all, that loss of innocence wasn’t too bad a consequence of growing maturity. MT